Clinical characteristics of fast and slow progressors of infarct growth in anterior circulation large vessel occlusion stroke

Abstract

Fast and slow progressor phenotypes of infarct growth due to anterior circulation large vessel occlusion (ACLVO) remain poorly understood. We aimed to define clinical predictors of fast and slow progressors in a retrospective study of patients with ACLVO who underwent baseline advanced imaging within 24 hours of stroke onset. Fast progressors (ischemic core > 70 ml, < 6 hours after onset) and slow progressors (ischemic core ≤ 30 ml, 6 to 24 hours after onset) were identified amongst 185 patients. Clinical and laboratory variables were tested for association with fast or slow progressor status. In the early epoch, no significant differences were found between fast progressors and controls. In the delayed epoch, slow progressors had a median NIHSS of 14 versus 20 (p < 0.01) and MCA occlusion in 80% versus 63% (p < 0.05) relative to controls. In multivariate analyses, NIHSS (OR 0.83, 95% CI 0.73-0.95), hyperlipidemia (OR 4.24, 95% CI 1.01 – 19.3) and hemoglobin concentration (OR 0.75, 95% CI 0.57 – 0.99) were independently associated with slow progressor status. This study indicates that lower initial stroke symptom severity, a history of hyperlipidemia and mild anemia are associated with individual tolerance to ACLVO stroke.

Hi1a Improves Sensorimotor Deficit following Endothelin-1-Induced Stroke in Rats but Does Not Improve Functional Outcomes following Filament-Induced Stroke in Mice

“…In contrast, in the filament model of MCAO, the infarct size has been shown to reach its peak as early as 6–8 h poststroke. , Clinically, patients can be categorized as fast or slow progressors following stroke, which refers to the rate of infarct growth and the presence and integrity of collateral circulation . Fast progressors show a large infarct core with failing collateral circulation, even within 6 h of stroke onset, whereas slow progressors show a smaller infarct core and better collaterals, resulting in a larger penumbra, and the presence of salvageable tissue beyond the 6 h window. − Therefore, the filament model of MCAO, with a faster-developing infarct, is more representative of fast progressing stroke patients, whereas the ET-1 model, with slower infarct growth, is more representative of slowly progressing patients.…”

Review of Cerebral Collateral Circulation and Insight into Cardiovascular Strategies to Limit Collateral Damage in Ischemic Stroke

“…This is exhibited clinically as slow-progressors (≈55% of anterior circulation LVO strokes) who seem to experience slow infarct growth and small ischemic cores despite delayed presentations. 24 Such patients may benefit significantly despite delayed interventions.…”

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial

“…Various definitions have been used to determine the infarct growth velocity and to classify patients as slow or fast progressors. Among the available literature, quickness of ischemic core extension has previously been measured using either absolute volume or Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast computed tomography (CT), diffusion weighted imaging or perfusion imaging [4][5][6][7][8][9][10][11][12] . Initial infarct core volume should then be referred to time from onset to imaging in order to appreciate the velocity of ischemic constitution.…”